Quaker Steak & Lube® Employment Application Personal Information: Last Name: First Name: Middle Initial/Name: Social Security Number: E-mail Address: Phone (xxx-xxx-xxxx): Address (Number & Street): City, State, ZIP: Can you, at the time of employment, submit verification of your legal right to work in the U.S.? - Select Yes or No - Yes No Are you at least 15 years of age? - Select Yes or No - Yes No If driving is an essential function of the job, do you have a valid driver's license? - Select Yes or No - Yes No License Number: State Issued: License Class: IF APPLYING TO A LOCATION IN MASSACHUSETTS, HAWAII, CITY OF PHILADELPHIA, OR CANADA, SELECT THE LAST REPONSE BELOW. IF APPLYING TO A LOCATION IN INDIANA, ANSWER "NO" IF YOUR FELONY HAS BEEN EXPUNGED BY A COURT. IF YOU PLAN TO WORK IN CALIFORNIA, CONNECTICUT, DISTRICT OF COLUMBIA, GEORGIA, KENTUCKY, NEVADA, NEW YORK, OHIO, UTAH, OR WASHINGTON, YOU MAY INDICATE "NO" IF CERTAIN CONDITIONS APPLY. OTHERWISE, YOU MUST ANSWER "YES" OR "NO." During the past 7 years, have you ever been convicted of a misdemeanor or felony, or plead guilty or no contest to such an offense? Please indicate "NO" if you have never been convicted of a crime or your conviction has been sealed, expunged, or annulled. You may also indicate "NO" of violations, infraction, petty misdemeanors, summary offenses, or minor traffic violations (Note: DWI, Evading, Hit and Run, or other similar traffic-related offenses are not considered minor). Answering "YES" will not necessarily bar you from employment, but failure to honestly answer this question will disqualify your application and/or lead to you termination. - Select One of the Following - Yes, I have been convicted of a misdemeanor or felony No, I haven't been convicted of a misdemeanor or felony I am applying in Massachusetts, Hawaii, Philadelphia or Canada QSL Employment Information: Placement Information Available Start Date: Desired Position: - Select A Position - Server Bartender Host Line Cook Expeditor Wingo Bus Dishwasher Maintenance Manager Salary Requested: Salary Per Hour or Year: - Select Per Hour or Year - Hour Year Desired Lube Location: - Select A Lube Location - FL - Pinellas Park (Clearwater) IA - Council Bluffs IN - Portage KY - Florence OH - Canton OH - Cleveland Airport OH - Colerain OH - Columbus OH - Medina Township OH - Mentor OH - Milford OH - Quicken Loans Arena (Cleveland) PA - Bloomsburg PA - Cranberry Township PA - Erie PA - Heinz Field (Pittsburg) PA - Johnstown PA - Mechanicsburg PA - PNC Park (Pittsburgh) PA - Robinson PA - Slippery Rock University PA - State College PA - York SC - Columbia SC - Greenville TN - Knoxville TN - Sevierville VA - Bristol WV - Charleston WI - Janesville WI - Middleton WI - New Berlin Are You Available Full Time or Part Time? - Select Availability - Full Time Part Time Available Both General Information Have you ever worked for a Quaker Steak & Lube? - Select Yes or No - Yes No If Yes What QS&L Location? If Yes When? Do you have any relatives or friends working for Quaker Steak & Lube? - Select Yes or No - Yes No If Yes What Is Your Relationship? Education High School Name and address of schoolName and address of school List degress, skill, or computer proficiencyList degress, skill, etc College, Trade, Business or Other Schools Name and address of schoolName and address of school List degress, skill, or computer proficiencyList degress, skill, etc Work Experience Please start with your most recent position. Job One Company Month/Year Hired Month/Year Left Address Supervisor Phone Position/Duties Reason For Leaving Job Two Company Month/Year Hired Month/Year Left Address Supervisor Phone Position/Duties Reason For Leaving Personal Reference List below a person not related whom you have known for over one year. Reference NameReference Name Address & Phone NumberReference Contact Info BusinessReference Business Years KnownReference Years Known I certify that the information provided by me in this application is correct to the best of my knowledge and understand that falsifying any of this information is grounds for denial of employment or immediate discharge if I am hired. I authorize references to provide any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release from them any liability or damages, which may result from furnishing this information. I understand that nothing in this document, or in granting an interview, creates any type of employment contract between Quaker Steak & Lube®/ Best Wings USA or related companies and me, and that the afore mentioned companies have the right to terminate my employment at any time and that I retain the same right.